The Neurological Emergencies Treatment Trials (NETT) Network has successfully established a clinical research network including emergency physicians, neurologists and neurosurgeons. The network's goals are to efficiently develop better treatments for patients with acute neurological disorders through execution of NINDS-sponsored clinical trials (RFA-NS-06-002). The essential aim of the NETT Network is to expedite recruitment into clinical trials. The Greater Cincinnati/Northern Kentucky NETT Hub and Spoke System was one of seventeen original Clinical Site Hubs funded under the 2006 Request for Applications. To date, our Cincinnati NETT Hub and Spoke System has enrolled over 226 patients in trials being conducted through the NETT Network. This positions us as the 2nd highest enroller among NETT Hubs. In this renewal application, we build on the success of our existing Hub and Spoke System with the following specific aims: #1) Efficiently recruit and retain participants and optimize data quality in NETT trials; and, #2) Actively contribute to the overall success of the NETT Network. To achieve these aims, we have identified four key ingredients that contribute to our continued success. These include: strong and ongoing institutional and community support; access to a demographic representative of the populations to which results must be generalized; unfiltered access to the full spectrum of acute neurologic disease and injury; and, active participation in and contributory to the efforts of the NETT Network. In this competitive renewal application, we demonstrate the strong and unwavering support of key players at our Hub including the Dean of the College of Medicine and the CEO of our Hub hospital. Further, we show a strong, multidisciplinary commitment to the success of our Hub and Spoke System embodied in our Advisory Committee members which include the Chairmen of Neurology and Neurosurgery, the PI of our CTSA, the Director of the Division of Trauma, and the COO of a large health system in Greater Cincinnati whose purview includes five of our Spoke hospitals. In addition to the high level support we receive from Institutional an community leaders, we demonstrate our ability to access the appropriate patient populations by presenting data on the relevant disease processes and showing the unyielding support we have from 'boots-on-the-ground' personnel from Medical Directors to bedside nurses. We have and will continue to be actively engaged in all NETT Network activities in order to learn how we may continue to optimize our Hub and Spoke System while also sharing our experience in ways that may be beneficial to other Hubs.